Permit ,, CITY OF TIGARD MECHANICAL PERMIT
° '! COM MUNITY DEVELOPMENT Pe rmit #: MEC2011 -00115
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/17/2011
Parcel: 2S 103AA01600
Jurisdiction: Tigard
Site address: 10830 SW WALNUT ST
Project: Edwards Subdivision: Lot: 0
Project Description: Install a/c unit. Unit must meet 3' minimum rear and side yard setbacks.
Contractor: FOUR SEASONS HEATING & A/C INC. Owner: EDWARDS, LES M AND MARCIA L
1005 INDUSTRIAL PARKWAY 10830 SW WALNUT
NEWBERG, OR 97132 TIGARD, OR 97223
PHONE: 503 - 538 -1950 PHONE: 503 - 475 -3117
FAX: 503 - 538 -0165
FEES
Specifics: Description Date Amount
Air Conditioning 03/17/2011 $46.75
Type of Use: SF 12% State Surcharge - Mechanical 03/17/2011 $10.80
Class of Work: OTR Type of Const: Minimum Fee Adjustment - Mechanical 03/17/2011 $43.25
Occupancy Grp:
Stories:
Fuel
Fuel Types:
Gas Pressure:
Total $100.80
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
or direct questions _to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ��014-1 Permittee SignatureC___ e
( �.-,
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
03/17 /2011 10:43 FAX 5035380165 Z002/004
Mechanical Permit ADplicatio ECEIVEf t,;is c,i t i< i i , --i u..,1
Sli City of Tigard R16ei Permit Nn Ntek
13125 SW Hall Blvd., Tigard, OR 97223 i A R 0 " � .- •
Phone: 503.639.4171 Pax: 503.598.1960 D a y . Other Permit;
Inspectiori Line: s 75 CITY OF TIGARD ''
ILDING DIVISION
• .... eta, ,.. :•.
El New Construction i / Addition/aiteratioNteplacement Mechanical permit fees* are based on the value of the wotk
perfbrmed. Indicate the value (rounded to the neatest dollar) of all
❑ Demolition i a'1 er: mechanical materials, equipment, labor, overhead, and profit.
,,. 4 .. „
. ," �'� :�" . , ; T .. . - ', ., Val
I- and 2 - family dwelling ❑ Commercial/industrial [] Accessory building i fs
(Multi - fatally Q Master builder ❑Other. For special information use checklist,
Dcscriptian I Qty. { Ea. I Total
JO8 ant tiiroantaina/f.010.10altett; r Heating/cooling
Job site address: Q ( Air conditioning p jj
(requires sitaylan ahawin a placement) 1 46.75
City /State/ZIP: • • s `-'1 2Z 3 Furnace 100,000 BTL! (ducta/vents) 46.75 -
"" Furnace 100,000+ BTU_(duots/vents) 54.91
Suite/bldg./apt- no.: ' • ject name: i/d. -_. Heat pump b1,06
Cross street /directions to job site: Duct wank 23.32
- Hydronic hot water system _ 23.32
_ Residential boiler (radiator or
hydronicl _ 23.32
. Unit heaters (fuel - type, not electric),
in -wall, in -duet, suspended, etc. 46.75
Lot no.: Flue/vent for any of above 23.32
Subdivision: Other: 23.32
Tax map/parcel no.: Other fuel appliances
,;, Water heater 2332 -- r ' Gras fireplace 33.39
r c ( V\ i'R.__ ( -Flue vent for water heater or gas _
fireplace 23.32
-- - - .. Log lighter (gas) 23.32
Wood/pellet stove 33.39
Wood fireplace/insert 23.32
----,--V..----: p�p,
Chimney/liner/flue/vent 2 1
_ . . ■ , Other:
Name: - ►,4. • a g . "I . � Environmental exhaust and ventilation
Address: ‘ 4 ' r _ , + Range hood/other kitchen 33.39
City/State/ZIP: t ei A e l ,� # r Clothes dryer exhaust 33 - 39
•
Single -duct exhaust (bathrooms,
Phone: ( 0 • ,,� ' Fax: ( ) toilet compartments, utility rooms) , 2
c/crawlspace fans _ 2332 „• • a a �; - : Altini 23.32 -
Business muae: •1 : -.« ► . . _ I . Fuel
piping
Contain n om; $14.15 for first four; 54.03 for each Additional
Furnace, eta _
Address: Gas heat pump
City/State/VP: Wallisuspended/unit heater
Phone: ( ) l ( ) Water heater - 7
--- Fireplace • -
E -mail: Rawae
BS[beCgC
Business nam : Clothes dryer (gas) -
Address: AND AIR CONDMONING, INC. — Add ress:
MECHANICALMIOT Par
cityistase/z1P :1005 INDUSTRIAL PKWY 503-63'8 – b/67) subtotal ' PIp, 00 '
Phone: ( ) A i : c • - • i` : ( 0 ' - 5 . , Minimum 25% fee permit fee)
,
_ _ Pl an review (23°x6 of pcmut fee)
CCB lie.: ,or` State surcharge (12 %ofPermit fie)
TOTAL PERMIT FEE VI
..
Authorized s 'r h. I t ip 8 This permit application expires it ■ permit is not obtained within 18a
days after it has been accepted as complete,
Print name; riff! t • - Data; • Fee methodoto$y set by Tri- County Building Industry Service Board t.
1:1Bull Psrmitaeac^I'ermkM,RAoc /0101104 4 •17I 0 Jra/COMh 6)
03/17/2011 10:44 FAX 5035380165 a003/004
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